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This role with OptumHealth will call on your knowledge, energy and commitment to making health care work more effectively. You will manage complex provider contracts, cost trend, relationships and network growth/strategy for Optum’s cellular therapy/CAR T provider network through provider negotiations with hospitals and health systems. This position is responsible for executing on network strategies to meet client and product goals; contracting competitive rates; evolving the payment methodology; and managing provider relationships.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
- Analyze and evaluate bundle payment and high-cost drug reimbursement for various contracting approaches and methodologies
- Work with several data sources to evaluate and develop market rates and provider performance profiles (e.g., billing patterns; referral patterns; quality and effectiveness) in order to establish provider rates and negotiation strategies
- Explain the organization's direction and strategy to providers in order to justify methodologies, processes, policies, and procedures
- Input contract projections accurately into appropriate tools and analyze financial impact of provider contracts to achieve company goals
- Communicate proposed contractual terms with provider and negotiate mutually acceptable agreement
- Establish and manage relationships with providers to navigate operational, legal, financial and clinical matters
- Reviewing contract redlines and developing responses that adhere to the applicable legal, financial, regulatory, and operational requirements
- Work across internal and external functional areas to address and resolve provider issues
In this role, you will need to be able to thrive in a demanding, intense, fast-paced environment. In addition, you’ll be driving some complex negotiations while striving to ensure accuracy.
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
- 4+ years of experience in a network management-related role handling network providers with accountability for business results
- 2+ years of experience with provider contracting including development of product pricing and utilizing financial modeling in making rate decisions
- Knowledge of bundle/case rate methodology, Medicare Resource Based Relative Value System (RBRVS), DRGs, etc.
- Knowledge of Medicare and Medicaid regulations
- Intermediate to advanced level of proficiency with MS Excel
- Ability to travel up to 10%
Preferred Qualifications:
- Large academic facility negotiations experience
- Familiarity with government pricing and coding
- Familiarity with high-cost drug pricing and coding
- Cellular therapy or complex condition provider contracting
- Proven excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information form others, including but not limited to reimbursement policy standards
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington or Washington, D.C. Residents Only: The salary range for this role is $88,000 to $173,200 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
